Sleep Before and After Retirement

Wakefulness after sleep offset and the elevated risk of mortality in older adults with evening preferences: A community-based 5-year longitudinal study

BACKGROUND AND OBJECTIVES

This study investigated the relationship between wakefulness after sleep offset timing (WASF), evening chronotype preferences, and mortality risk in community-dwelling older adults.

RESEARCH DESIGN AND METHODS

We conducted a community-based longitudinal study with a sample of 4167 older adults aged ≥60. The sleep characteristics, WASF, subjective chronotype preferences, and other relevant variables of the participants at baseline were evaluated. We examined the association between WASF and mortality over a 5-year period using Cox proportional hazards models, with stratification by subjective chronotype preferences to explore potential effect modification.

RESULTS

Data from 3734 participants were analyzed (71.1 ± 6.9 years; 2114 [56.6 %] women). The 5-year mortality incidence was 6.3 %. Overall, participants had a median (IQR) of 5.0 (2-20) min WASF, and 767 (20.6 %) were evening types. WASF of ≤5 min = 10.6 (95 % CI, 8.9-12.8), WASF of >5 min = 14.6 (95 % CI, 12.1-17.6). The mortality incidence rates per 1000 person-years were: WASF of ≤5 min = 10.6 (95 % CI, 8.9-12.8) and WASF of >5 min = 14.6 (95 % CI, 12.1-17.6). Even after adjusting for covariates, the longer WASF participants had a higher hazard ratio of 1.40 (95 % CI, 1.04-1.88) compared to the shorter WASF participants. Regular, prolonged WASF was found to be significantly associated with an increased risk of mortality among evening-type individuals (2.69; 95 % CI: 1.19-6.08) in the stratified model based on subjective chronotype preferences. However, we found no statistically significant association among the other types.

DISCUSSION AND IMPLICATIONS

Reducing morning time in bed, and addressing prolonged WASF are crucial factors in decreasing mortality risk among older adults, especially among those with evening preferences.

Multidimensional Sleep and Self-Rated Physical Health and Depressive Symptoms Among Retired Older Adults: A Sex-Stratified Analysis

OBJECTIVES

Individual sleep characteristics have been shown to independently influence physical and mental health in older adults, but these characteristics are often interdependent. However, few studies have explored multidimensional sleep health in relation to self-rated health outcomes among retired older adults, particularly with regard to sex differences. This study examined the associations between multidimensional sleep health, and self-rated physical and mental (i.e. depressive symptoms) health in retired older adults (M years of retirement = 6.59), stratified by sex.

METHODS

Participants (n = 154; Mage = 68.4, 55.2% female) reported physical health (RAND-12) and depressive symptoms (CES-D). Multidimensional sleep health was measured using wrist actigraphy to assess sleep efficiency, timing, duration, and regularity, and sleep diaries to evaluate daytime alertness and sleep satisfaction. Each component was dichotomized and summed for a composite score (0-6). Hierarchical linear regressions examined the relationships between multidimensional sleep health and health outcomes.

RESULTS

Women had poorer multidimensional sleep health compared to men. In the full sample, poorer multidimensional sleep health was associated with worse self-rated physical health and depressive symptoms. Sex-stratified analyses revealed significant associations only in women.

CONCLUSION

Multidimensional sleep health is associated with self-rated physical health and depressive symptoms in older retired women. Future research should explore why sleep health may be more salient for self-rated physical health and depressive symptoms in women vs. men and their links to health outcomes, providing insights for tailored interventions.

Sleep Timing Across the Lifespan of Australian Adults

The aim of this study was to examine sleep timing across the lifespan of Australian adults. A cross-sectional design was used to collect information on subjective sleep timing from 1225 participants (52.3% female) during a telephone interview. The participants were aged from 18 to over 80 and were grouped according to their age using 10-year increments (e.g., 18-29 y, 30-39 y, etc.). There was a diverse distribution across the lifespans, with the largest proportion of participants being from the 60-69 age group (22.8%). Participants were predominantly from New South Wales, Queensland, and Victoria. Younger adults reported going to bed later (p < 0.001) and waking up later than other age groups (p < 0.001). Wake times were earliest during middle adulthood (p < 0.001). There was no significant age effect on the minimum sleep required for good health (p = 0.159) and only a marginal decrease with age in the amount of sleep required to maintain a good mood (p = 0.041). In conclusion, these findings highlight significant variations in sleep timing across younger, middle-aged, and older Australian adults. The current findings could inform future Australian sleep health campaigns, in which the goal is to provide targeted strategies for age groups across their lifespans.

Rural-urban differences in the association between afternoon napping and depressive symptoms among middle-aged and older adults in China

OBJECTIVE

This study aimed to examine the association between afternoon napping and depressive symptoms among Chinese middle-aged and older adults and to evaluate the rural-urban differences.

METHODS

A total of 11,056 participants, aged≥45, 5646 rural and 5410 urban, were included using data from CFPS. Each participant provided data on afternoon napping through field interviews. CESD8 was used to measure depressive symptoms. Multivariable logistic regressions were used to investigate the association.

RESULTS

2654 (24.01 %) participants had depressive symptoms and 7239 (65.48 %) napped. Nappers were likely to have a lower risk of depressive symptoms (OR = 0.899; 95%CI =0.816-0.991). A significantly lower risk of depressive symptoms was found in the moderate-duration afternoon napping groups (31-60 min/day) compared with non-nappers (OR = 0.816; 95%CI =0.727-0.917). In terms of rural-urban differences, rural participants had a lower risk of depressive symptoms compared with non-nappers (OR = 0.813; 95%CI =0.716-0.926). A significant association was also found between age groups. Participants aged 65-74 years old had a lower risk of depressive symptoms compared with non-nappers (OR = 0.776; 95%CI = 0.627-0.959).

LIMITATIONS

First, the cross-sectional study may limit the ability to infer causality. Second, only those who responded to the questionnaire were included; selection bias was unavoidable. Finally, answers were retrospective self-reported, which may cause recall bias and social desirability bias.

CONCLUSIONS

Afternoon napping was associated with a lower risk of depressive symptoms among Chinese middle-aged and older adults. The associations varied between rural-urban and age groups. We recommend taking a moderate-duration afternoon napping every day to prevent the risk of potential depression.

Who sleeps well in Canada? The social determinants of sleep health among middle-aged and older adults in the Canadian Longitudinal Study on Aging

OBJECTIVES

Sleep health inequities likely contribute to disparities in health outcomes. Our objective was to identify social determinants of sleep health among middle-aged/older adults in Canada, where prior evidence is limited.

METHODS

We analyzed cross-sectional data from the Canadian Longitudinal Study on Aging, a survey of over 30,000 community-dwelling adults aged 45-85years. Self-reported measures included sleep duration, sleep satisfaction, and sleep efficiency. We explored associations between sleep measures and social determinants of health. We used modified Poisson regression to estimate prevalence ratios for sleep satisfaction and sleep efficiency, and linear regression for sleep duration. Estimates were adjusted for all social, lifestyle, and clinical covariates. We explored effect modification by sex.

RESULTS

Of the 11 social determinants explored, all were significantly associated with at least one domain of sleep health. These associations were reduced to 9 variables with adjustment for all social variables, and 7 with further adjustment for lifestyle and clinical covariates, including differences by sex, age, education, marital status, employment, race/ethnicity, and sexual orientation. Better sleep health in >1 domain was observed among males, older age groups (65 and older), higher income groups, the retired group, and homeowners with adjustment for social variables, and only in males and older age groups with additional adjustment for lifestyle and clinical variables. Only sleep duration associations were modified by sex.

CONCLUSIONS

Sleep health disparities among Canadian adults exist across socioeconomic gradients and racial/ethnic minority groups. Poor sleep health among disadvantaged groups warrants increased attention as a public health problem in Canada.

Understanding the Need for Sleep to Improve Cognition

The restorative function of sleep is shaped by its duration, timing, continuity, subjective quality, and efficiency. Current sleep recommendations specify only nocturnal duration and have been largely derived from sleep self-reports that can be imprecise and miss relevant details. Sleep duration, preferred timing, and ability to withstand sleep deprivation are heritable traits whose expression may change with age and affect the optimal sleep prescription for an individual. Prevailing societal norms and circumstances related to work and relationships interact to influence sleep opportunity and quality. The value of allocating time for sleep is revealed by the impact of its restriction on behavior, functional brain imaging, sleep macrostructure, and late-life cognition. Augmentation of sleep slow oscillations and spindles have been proposed for enhancing sleep quality, but they inconsistently achieve their goal. Crafting bespoke sleep recommendations could benefit from large-scale, longitudinal collection of objective sleep data integrated with behavioral and self-reported data.

Association Between Excess Sleep Duration and Risk of Stroke: A Population-Based Study

BACKGROUND

Excess sleep is associated with higher risk of stroke, but whether the risk is modified by age and if it remains elevated after accounting for the competing risk of death is not well understood.

METHODS

We used nine years of the Canadian Community Health Survey between 2000 to 2016 to obtain self-reported sleep duration and created a cohort of individuals without prior stroke, heart disease, or cancer. We linked to hospital records to determine subsequent admissions or emergency department visits for acute stroke until December 31, 2017. We used Cox proportional hazard models to determine the association between sleep duration and risk of stroke, assessing for modification by age and sex and adjusting for demographic, vascular, and social factors. We obtained cumulative incidence of stroke accounting for the competing risk of death.

RESULTS

There were 82,795 individuals in our cohort who met inclusion criteria and had self-reported sleep duration, with 1705 stroke events in follow-up. There was an association between excess sleep (≥10 h/night) and risk of stroke in those <70 years (fully adjusted hazard ratio 2.29, 95% CI 1.04-5.06), but not ≥70 years of age, with a similar association after accounting for the competing risk of death.

CONCLUSION

Sleep duration ≥10 h/night is associated with increased risk of stroke in those <70 years of age. The findings support current guidelines for 7-9 h of sleep per night. Further research is needed to elucidate the relationship between sleep and cerebrovascular disease.

Understanding the effect of retirement on health behaviors in China: Causality, heterogeneity and time-varying effect

Retirement is an important turning point during the course of life, but few studies have examined the effects of retirement on a broad range of health behaviors in China. We use the longitudinal data of the China Health and Nutrition Survey (CHNS) from 2004 to 2015 to conduct empirical analysis. Fuzzy discontinuity regression was used to assess the association between retirement and health behaviors in the entire sample and subgroups based on gender and education. A time-varying effect model was used to measure the anticipatory effect, immediate effect and lag effect of retirement. We observed that the transition to retirement was associated with healthier lifestyle habits, such as reduced smoking and alcohol consumption and increased exercise motivation. However, the transition was associated with worse sedentary behavior. No significant statistical association was found between retirement and sleep duration. Men and those with higher education levels are more likely to experience the impact of retirement. The anticipatory effect suggests that as the statutory pension age is predictable, workers adjust their behaviors 4 and 5 years before retirement. The lagged effect indicates that it takes time to develop new habits; thus, retirees change their behaviors 2-3 years after retirement. The paper discusses possible reasons for our findings and proposes several policy implications from the perspectives of the government and society to facilitate the realization of healthy aging.

Involuntary Retirement and Depression Among Adults: A Systematic Review and Meta-Analysis of Longitudinal Studies

Results from longitudinal studies on involuntary retirement and depression remain controversial. PubMed, Web of Science, Embase, ScienceDirect, Wanfang, and VIP updated on 4 January 2022 were searched for eligible publications. Pooled relative risks (RRs) with 95% confidence interval (CI) were calculated using a random-effects model. Eight published articles with 14,604 participants for the effect of involuntary retirement on depression incidence and 26,822 participants for the relationship between depression and involuntary retirement were included. Compared with working, the pooled RR for depression was 1.31 (95% CI, 1.13-1.51; I ² = 37.7%) for the involuntary retirement overall. For involuntary retirement, the pooled RR was 1.70 (95% CI, 1.28-2.25; I ² = 84.2%). The associations between involuntary retirement and depression did not substantially change in sensitivity and subgroup analyses. No evidence of publication bias was found. This meta-analysis indicates that there might be mutual causal relationship between involuntary retirement and depression. More large longitudinal studies with different gender and income levels are needed.

Daytime fatigue as a predictor for subsequent retirement among older New Zealand workers

OBJECTIVES

There is limited information on the role of fatigue on retirement, either independently or in association with poor sleep. The aim of this study was to examine the prospective association between daytime fatigue, measured as feeling tired or feeling worn out, independently and in relation to dissatisfaction with sleep, and subsequent retirement among 960 older workers in New Zealand.

METHODS

Data from 2 consecutive surveys (2008 and 2010) of the New Zealand Health, Work, and Retirement Longitudinal Study were used. Poisson regression was used to investigate whether feeling tired and feeling worn out in 2008, along with dissatisfaction with sleep, were associated with self-reported retirement either due to health reasons or other reasons by 2010.

RESULTS

The risk for retirement due to health reasons during a 2-year follow-up was 1.80-fold (95% confidence interval [CI] 1.16-2.45) among those who felt tired and 1.99-fold (95% CI 1.34-2.64) among those who felt worn out when compared to those not tired or not feeling worn out after adjusting for several sociodemographic, work characteristics and self-rated health. The risk for retirement due to health reasons was even higher when participant experienced both tiredness and feeling worn out. Dissatisfaction with sleep did not predict retirement due to health or other reasons.

CONCLUSIONS

Our results highlight that workers at risk of subsequent retirement due to health reasons may be identified with rather simple questions on tiredness and feeling worn out even among generally healthy older workers.

Changes in accelerometer-measured sleep during the transition to retirement: the Finnish Retirement and Aging (FIREA) study

STUDY OBJECTIVES

Retirement is associated with increases in self-reported sleep duration and reductions in sleep difficulties, but these findings need to be confirmed by using more objective measurement tools. This study aimed at examining accelerometer-based sleep before and after retirement and at identifying trajectories of sleep duration around retirement.

METHODS

The study population consisted of 420 participants of the Finnish Retirement and Aging study. Participants' sleep timing, sleep duration, time in bed, and sleep efficiency were measured annually using a wrist-worn triaxial ActiGraph accelerometer on average 3.4 times around retirement. In the analyses, sleep on nights before working days and on nights before days off prior to retirement were separately examined in relation to nights after retirement.

RESULTS

Both in bed and out bed times were delayed after retirement compared with nights before working days. Sleep duration increased on average by 41 min (95% confidence interval [CI] = 35 to 46 min) from nights before working days and decreased by 13 min (95% CI = -20 to -6 min) from nights before days off compared with nights after retirement. By using latent trajectory analysis, three trajectories of sleep duration around retirement were identified: (1) shorter mid-range sleep duration with increase at retirement, (2) longer mid-range sleep duration with increase at retirement, and (3) constantly short sleep duration.

CONCLUSIONS

Accelerometer measurements support previous findings of increased sleep duration after retirement. After retirement, especially out bed times are delayed, thus, closely resembling sleep on pre-retirement nights before non-working days.

Impact of Retirement on Sleep Problems Among Older Workers and Their Partners

BACKGROUND AND OBJECTIVES

Sleep problems are a public health burden and have adverse health consequences in older adults. Despite sleep being a shared biological process between couples, to date there have not been any studies that have assessed the association between retirement and sleep, in older couples. The objective of this study was to examine the impact of retirement on diagnosed sleep problems in older Dutch couples.

RESEARCH DESIGN AND METHODS

This study used data from two waves of the NIDI Pension Panel Study for older Dutch adults living with a partner (n= 3,726). Logistic regression models examined the strength of association between retirement and sleep problems, while accounting for the moderating role of relationship characteristics.

RESULTS

Retirement was associated with decreased odds of sleep problems at wave 2 (OR= 0.60, 95%CI=0.46-0.78). Lower relationship quality was associated with increased odds of sleep problems in the fully adjusted model (OR=1.81, 95%CI=1.32-2.49). Having a partner with sleep problems was associated with increased risk of sleep problems as well (OR=1.51, 95%CI=1.07-2.13). There was evidence of effect modification by relationship quality (OR= 1.87, 95%CI =1.05-3.31).

DISCISSION AND IMPLICATIONS

Retirement and sleep do not occur in a social vacuum and have implications beyond the individual level. More research is therefore needed to understand the impact of sleep and its health consequences on older coupled workers. Such research may provide valuable insights for management and treatment of sleep problems and may have implications for public health of aging communities.

Napping in Older Adults: A Review of Current Literature

Purpose of Review

Daytime napping-frequently reported among older populations-has attracted increasing attention in geriatric research due to its association with multiple health conditions. This review aims to integrate the latest knowledge about napping in older adults to provide implications for future research.

Recent Findings

The prevalence of napping in older adults ranges from 20% to 60% in different studies, but has been consistently reported to be higher than in other age groups. Age-related changes in circadian rhythm and sleep patterns, cultural beliefs, chronic conditions, medications, and lifestyle changes contribute to the high prevalence of napping in older adults. Daytime napping has been associated with multiple health conditions in older adults. Naps of short duration (e.g., 30 minutes) are reported in adults with better health; naps with longer durations (e.g., >90 minutes) have been linked to adverse cardiovascular and diabetes outcomes, declining cognitive function, and increased mortality. Current evidence in the literature, however, is not enough for us to determine the exact role of napping in the health of older adults.

Summary

Longitudinal and interventional studies are needed to investigate the influence of napping and the critical parameters such as duration, timing, and frequency on health in older adults and the underlying mechanisms. A combination of objective and self-reported measurements of napping are recommended instead of self-reported data only.